Diagnosis for Early Detection

There is a high level of evidence coming from large randomized controlled trials that primary human papillomavirus (HPV) screening is better than cytology in detecting cervical intraepithelial neoplasia type 3 and cervical cancer as well as in reducing the incidence of and the mortality from cervical cancer. However, HPV screening will only be beneficial and costefficient in women above 30 years and only in wellstructured programs with longer screening intervals. Pilot projects in the USA and Germany show that HPV screening is feasible even on local or regional levels with similar efficiency as observed in randomized controlled trials. The single remaining serious argument against screening with HPV testing, i.e. the missing algorithm for women with normal cytology who tested positive for HPV, may be solved by a triage using p16/Ki67stained cytology. Copyright © 2012 S. Karger AG, Basel During the last decades, Papanicolaou (Pap) smear screening programs significantly reduced the incidence of cervical cancer in most industrialized countries. Screening for cervical cancer is a socalled secondary prevention method because it does not prevent the full cycle of carcinogenesis. The central concept of this exceptionally successful cancer prevention is the identification and treatment of women with highgrade intraepithelial lesions [cervical intraepithelial neoplasia (CIN) 2 and CIN3]. Excision of these lesions interrupts the genesis of cervical cancer at a preinvasive stage. Although future human papillomavirus (HPV) vaccines may offer complete protection from all diseases caused by HPV [1], screening will be needed to prevent cervical cancer in nonvaccinated women and not per protocol vaccinated individuals for the next decades. Even women who were vaccinated per protocol will need to participate in screening programs as the current vaccines will prevent only 70– 80% of all highgrade CIN and invasive cancers. This reduction is equivalent to the effect of the established Pap smear programs. Combining vaccination and screening will offer best protection from cervical cancer.